It was just a kiss, the kind of kiss from a sibling that would make little Bear Brother react in adorable disgust.
The almost-1-year-old Bear was leaning on the couch when his sister Emma gave him a smooch as he tried to dodge it. He fell backward, onto his butt, and bonked his head on the floor.
Toddlers tumble, so his parents Lisa Hannigan and Robert Brother weren’t concerned. The next day, though, he seemed “funny,” oddly loose, his dad said. “When I picked him up he was just limp, noodle arms,” Robert said. They wondered if Bear had a virus.
A staffer at his day care called Lisa, troubled that Bear wasn’t grabbing everything as usual. He couldn’t wrap his fingers around his favorite toys.
Lisa rushed Bear to Astria Toppenish Hospital, where doctors recognized the symptoms of a spinal cord injury. By then, his right arm was completely limp. Taken to Seattle Children’s Hospital by ambulance, he underwent tests and an MRI scan, which showed why he lost the use of his arms and hands.
Bear had a Chiari malformation — a congenital condition that occurs when the back of the brain doesn’t entirely fit in the base of the skull and protrudes out of the bottom onto the top of the spinal cord. When he fell back and bonked his head, it caused the bone to hit the spinal cord, resulting in the injury.
Bear’s top vertebra was pushing down into the vertebra below it, applying pressure in his spinal cord.
On May 12 — the day before his 1st birthday — Bear underwent a 4-hour emergency decompression surgery. Dr. Jason Hauptman, a pediatric neurosurgeon, removed the base of Bear’s skull and his top vertebrae to take pressure off his lower brain stem and spinal cord.
The surgery is performed annually in hundreds of older patients at Seattle Children’s, mainly on teens and young adults. Bear was unique because he was so young. He’s the youngest patient on whom Hauptman has ever performed an emergency decompression.
“It required for me to very carefully remove some of the bone at the base of the skull and the backs of the top two vertebrae to relieve the pressure at the base of the brain and the top of the spine,” Hauptman explained.
Lisa and Robert wouldn’t know until after surgery whether Bear would be able to crawl, walk or move his upper body again. And they were shaken by the thought that if they had not responded so quickly, his prognosis could have been much worse.
“He’s my youngest and my only son,” Robert said.
Fixing a spinal cord injury
Bear Lee Ron Brother weighed 11 pounds when he was born three weeks early. “He would have been 12.5 pounds at full term,” said his mother, still marveling at his size.
Bears have special significance for Hannigan, 30. She grew up in the hills of the Yakima Valley, and her mother’s headstone features a bear. Robert, 29, a Portland native, grew up loving the woods. They have a strong connection with the outdoors and share that with their son and daughters Emma, 4, and Elizabeth, 11.
A robust toddler, Bear was bigger than some 1-year-olds when he was just 6 months old and wore the largest diapers.
“He really grew into his name,” Lisa said.
That made his sudden paralysis even more perplexing. Alone in the car as he followed Bear and Lisa in the ambulance from Toppenish to Seattle, Robert worried as he considered the possibilities.
Talking with doctors and surgeons as Bear underwent tests, they waited for answers.
“They’re throwing all these big words at me,” Robert said. “Just tell me if my son’s OK.”
Hauptman explained that Bear likely was born with the type I Chiari malformation. He was injured because, in a Chiari 1 malformation, there’s a narrowing where the skull meets the neck. In Bear’s case, that aperture was extraordinarily narrow, Hauptman said.
“The way Bear presented was a very unusual way to present. Normally it doesn’t present with an acute spinal cord injury like that, and normally not in a child that young,” Hauptman said.
Surgery required the cautious and meticulous removal of part of Bear’s skull with a variety of special instruments while ensuring that the spinal cord was carefully decompressed and not injured.
“We try to stabilize the injury so it doesn’t get worse and we try to set the stage for recovery to occur. It can sometimes take weeks, months or years,” Hauptman said. “The spinal cord is incredibly fragile and does not heal the way other parts of the body heal.”
Surrounded by family members as they waited in the Pediatric Intensive Care Unit, Lisa and Robert got the news that the surgery was successful. They thanked Hauptman for his extreme care with their son.
“I shook his hand. I told him, ‘Thank you,’” Robert said. “He told me, ‘I understand. When I see these kids, I think of my children. I treat them like my children.’”
Not long after surgery, Bear was lifting his arms and holding objects. The next day — within 12 hours — Bear was eating “a ton of food,” his parents said.
“He kept saying ‘more, more,’” Lisa said. “He had two applesauces. The nurses were like, ‘I cannot believe he was able to swallow it.’ He was lying down while he was doing this.”
And Bear was starting to move his fingers.
By the time he came home from the hospital on May 14, he was walking, picking up his toys and throwing his balls with no physical therapy necessary then or since.
“He recovered so quickly,” Lisa said.
It’s outstanding, Hauptman said. He and other medical experts plan to follow Bear as he grows.
“It’s the outcome I strive and I dream for every single time,” Hauptman added. “He’s so young; young children, babies in particular, have an incredible capacity to heal well beyond what you or I could possibly achieve.”
“He has his whole life ahead of him. He’s going to do wonderful things and he really recovered from the brink of a neurological catastrophe.”
Looking back, his parents remember little things. Bear gagged occasionally. He wobbled. Both seemed normal at the time, but they could have resulted from his Chiari malformation.
Up to 30 pounds now (his 4-year-old sister Emma weighs 43 pounds), Bear likes basketball. He tosses a toddler-sized ball through a hoop over and over. He also loves driving his Thomas the Tank Engine on a little circular track in the living room.
While Bear won’t be able to participate in contact sports like football and wrestling when he gets older, basketball is OK.
With a 21/2-inch scar on the back of his neck, Bear will always have a reminder of his medical mystery. His family won’t forget, either.
“His Sissy giving him a kiss was a godsend,” Robert said. “Thank you, Sissy.”